Training community health nurses to measure parent–child interaction: a mixed-methods study

Background This study aims to determine whether the Parental Responsiveness Rating Scale (PaRRiS) completed at child age 24–30 months can be used by community child health nurses (CCHNs) to reliably measure the quality of parent–child interactions in practice. Methods A mixed-methods design was used involving CCHNs working in public health settings. Five CCHNs recruited from the North-East of England were trained to use PaRRiS. Thirty parent–child dyads attending their routine 24–30-month check were observed. Nurses rated parent–child dyads during 5 min of free-play using PaRRiS. The free-play sessions were video recorded and rated blind by the first author to the nurse observation. Semi-structured phone interviews were conducted with the five CCHNs once observations of parent–child interactions were complete. Interviews were audio-recorded, transcribed, anonymized and thematically analyzed. Results Two-thirds of participating parents were mothers. Half the families (15/30) were from the 10% most deprived areas based on the English Index of Multiple Deprivation. The average PaRRiS score was 3.03 [standard deviation (SD) = 0.8; all ratings were <5.0]. Reliability between the first author (‘gold standard’) and CCHNs was excellent [Intra-class correlation coefficient (ICC): 0.85; 95% confidence interval (CI): 0.67–0.93]. CCHNs found PaRRiS aligned well with current practice and was acceptable to parents. There was no evidence of a relationship between social disadvantage and PaRRiS scores. Conclusions With further development and evaluation work, PaRRiS could potentially be incorporated into existing universal health services to provide child health nurses with an additional tool for identifying families most likely to be in need of parent–child interaction interventions

Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial

Objective To determine the benefits of a low intensity parent-toddler language promotion programme delivered to toddlers identified as slow to talk on screening in universal services

Working with the parents and families of children with developmental language disorders: An international perspective

Background The relationship between parental input and child language development has had a complex history. It has become clear that indirect parent training for the parents of children with delayed language development is an important feature of interventions offered by speech and language therapists in the anglophone countries. Yet we know less about how this type of approach is realised in other countries. Methods In this paper we report the results of a survey of practice undertaken as part of the work of COST Action IS1406, a European Union (EU) funded research network. The focus of this paper is specifically on parent-related questions and responses referring to children under the age of twelve. The survey was devised by members of the Action and circulated electronically during the summer of 2017. In all, 4024 practitioners responded from 60 countries, the majority of whom came from EU member countries. Findings Respondents to the survey indicated that indirect therapy is commonly carried out via the parent in the early years and via teachers later. A range of professional groups, in addition to speech and language therapists, is likely to adopt this approach; including teachers, pedagogues and psychologists. A variety of interventions is reported, some of which have a reasonable evidence-base underpinning them. It is interesting to see the widespread involvement of fathers and other family members in interventions. Finally, the fact that practitioner characteristics (age, experience, location of practice etc.) are not related to the use of indirect techniques points to the universal recognition of the value of these approaches. Conclusions Despite the very different traditions in the practice of intervention across countries, there is clearly a widespread recognition of the importance of indirect approaches to intervention and specifically those focusing on parents. The mixture of family members being involved in interventions is a very promising indication of the role sharing commonly associated with the contemporary family. Yet the number of specific intervention approaches identified is relatively small given the number of respondents. There is a need for a better understanding of what exactly practitioners are doing when they involve parents in intervention or carry out parent-child interaction interventions and how well these interventions work in routine practice. This also has implications for the application of evidence-based practice and the precise nature of the interventions concerned (advice to parents, video interaction training etc.).COST (European Cooperation in Science and Technology)Unión Europea Horizonte 2020 Marie Sklodowska-Curie grant agreement No. 70504

Improving outcomes of preschool language delay in the community: protocol for the Language for Learning randomised controlled trial

BackgroundEarly language delay is a high-prevalence condition of concern to parents and professionals. It may result in lifelong deficits not only in language function, but also in social, emotional/behavioural, academic and economic well-being. Such delays can lead to considerable costs to the individual, the family and to society more widely. The Language for Learning trial tests a population-based intervention in 4 year olds with measured language delay, to determine (1) if it improves language and associated outcomes at ages 5 and 6 years and (2) its cost-effectiveness for families and the health care system. Methods/DesignA large-scale randomised trial of a year-long intervention targeting preschoolers with language delay, nested within a well-documented, prospective, population-based cohort of 1464 children in Melbourne, Australia. All children received a 1.25-1.5 hour formal language assessment at their 4th birthday. The 200 children with expressive and/or receptive language scores more than 1.25 standard deviations below the mean were randomised into intervention or &lsquo;usual care&rsquo; control arms. The 20-session intervention program comprises 18 one-hour home-based therapeutic sessions in three 6-week blocks, an outcome assessment, and a final feed-back/forward planning session. The therapy utilises a &lsquo;step up-step down&rsquo; therapeutic approach depending on the child&rsquo;s language profile, severity and progress, with standardised, manualised activities covering the four language development domains of: vocabulary and grammar; narrative skills; comprehension monitoring; and phonological awareness/pre-literacy skills. Blinded follow-up assessments at ages 5 and 6 years measure the primary outcome of receptive and expressive language, and secondary outcomes of vocabulary, narrative, and phonological skills. DiscussionA key strength of this robust study is the implementation of a therapeutic framework that provides a standardised yet tailored approach for each child, with a focus on specific language domains known to be associated with later language and literacy. The trial responds to identified evidence gaps, has outcomes of direct relevance to families and the community, includes a well-developed economic analysis, and has the potential to improve long-term consequences of early language delay within a public health framework.<br /

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children

Happy Talk: A pilot effectiveness study of a targeted-selective speechâ language and communication intervention for children from areas of social disadvantage

Background: Despite the public health implications of language difficulties associated with social disadvantage, there is a dearth of effectiveness studies investigating the effects of targeted speech and language programmes in this area. Aims: To determine the effects of a targeted selective community-based child language intervention programme (Happy Talk), which simultaneously engaged with parents and early childhood educators, in the Republic of Ireland. Methods & Procedures: A mixed methods methodology was applied with quantitative outcome and qualitative process data collected. Effectiveness was examined using a quasi-experimental single blind study design comparing Happy Talk with ‘usual care’ across four preschools. Qualitative process data were also gathered to examine the acceptability and feasibility of the Happy Talk approach in practice, and to identify factors to improve the probability of successful wider implementation. Child language (PLS-5) and quality-of-life measures were administered pre- and immediately post- the 11-week intervention. Responsiveness was assessed as the parental outcome, and the oral language environment of preschools was measured using the Communication Supporting Classroom Observation Tool (CSCOT). Retrospective acceptability was analysed with reference to the theoretical framework of acceptability (v 2). Outcomes & Results: Pre-/post-expressive and composite language scores were collected for 58 children, and receptive scores for 54 children. Multiple linear regression revealed significant intervention effects for comprehension and total language with large and moderate effect sizes, respectively (0.60 and 0.46 SD). No significant effect was shown for parental responsiveness. No effects were found for the preschool environment or children's quality of life. Preschool staff deemed the programme to be an acceptable method of enhancing children's speech and language skills and rated the intervention positively. Conclusions & Implications: The Happy Talk pilot effectiveness trial shows that comprehension can be improved (with a large effect) in preschool children from areas of social disadvantage, following an 11-week intervention, in which parents and preschool staff are simultaneously engaged. The ecological validity of the programme, as well as feasibility and acceptability to staff, make it a suitable programme to be delivered at scale

EHLS at school: school-age follow-up of the early home learning study cluster randomized controlled trial

BACKGROUND: Targeted interventions during early childhood can assist families in providing strong foundations that promote children\u27s health and wellbeing across the life course. There is growing recognition that longer follow-up times are necessary to assess intervention outcomes, as effects may change as children develop. The Early Home Learning Study, or \u27EHLS\u27, comprised two cluster randomized controlled superiority trials of a brief parenting intervention, smalltalk, aimed at supporting parents to strengthen the early childhood home learning environment of infants (6-12&nbsp;months) or toddlers (12-36&nbsp;months). Results showed sustained improvements in parent-child interactions and the home environment at the 32&nbsp;week follow-up for the toddler but not the infant trial. The current study will therefore follow up the EHLS toddler cohort to primary school age, with the aim of addressing a gap in literature concerning long-term effects of early childhood interventions focused on improving school readiness and later developmental outcomes. METHODS: \u27EHLS at School\u27 is a school-aged follow-up study of the toddler cluster randomized controlled trial (n&thinsp;=&thinsp;1226). Data will be collected by parent-, child- and teacher-report questionnaires, recorded observations of parent-child interactions, and direct child assessment when children are aged 7.5&nbsp;years old. Data linkage will provide additional data on child health and academic functioning at ages 5, 8 and 10&nbsp;years. Child outcomes will be compared for families allocated to standard/usual care (control) versus those allocated to the smalltalk program (group program only or group program with additional home coaching). DISCUSSION: Findings from The Early Home Learning Study provided evidence of the benefits of the smalltalk intervention delivered via facilitated playgroups for parents of toddlers. The EHLS at School Study aims to examine the long-term outcomes of this initiative to determine whether improvements in the quality of the parent-child relationship persist over time and translate into benefits for children\u27s social, academic and behavioral skills that last into the school years

Understanding parent behaviours that promote language in slow-to-talk toddlers

© 2013 Dr. Penny Anne LevickisBackground: Parent-child interaction is thought to play a crucial role in language development. Specific maternal responsive behaviours have been shown to predict subsequent language outcomes in small, clinical samples of children with language delay and in selected samples of typically developing children followed longitudinally. It is not known whether similar findings apply in population-based samples of toddlers screened and found to be at risk for language delay. Establishing the contribution of specific maternal behaviours to child language development could not only advance theories of language acquisition, but also assist in population strategies for better identifying children at risk of lasting language problems. Aims: This doctoral research aimed to: 1. develop a valid, replicable, low-burden mechanism for observing and coding specific maternal responsive behaviours (imitations, interpretations, labels, expansions, supportive directives and responsive questions) for a population-based cohort of 24 month old children who were slow to talk at 18 months (i.e., a sample enriched for likely later language delay) 2. prospectively quantify the degree to which: a) these behaviours at 24 months predict language outcomes concurrently and at 36 months; and b) an overall maternal responsiveness score derived from the six individual maternal responsive behaviours predicts language scores at both 24 and 36 months over and above contributions of standard risk factors and earlier language scores. Methods: This prospective longitudinal study was derived from a population-based survey in Melbourne, Australia. Participants were mother-child dyads from three Melbourne regions spanning the socioeconomic spectrum. At age 18 months, 1138 (93.5%) parents completed a 100-word expressive vocabulary checklist; the 251 (22.1%) children scoring ≤20th percentile were eligible for the current study. At age 24 months, mother-child dyads were video recorded during 15 minutes of free-play. The predictors derived from the videotaped language samples were the maternal responsive behaviours of expansions, imitations, interpretations, labels, supportive directives and responsive questions, which were coded using the Observer® XT software. The outcomes, measured at ages 24 and 36 months, were the Preschool Language Scale-4 (norm-referenced receptive and expressive language). Secondary outcomes were parent-reported expressive vocabulary measured by the Sure Start Language Measure 100-word vocabulary checklist at 24 months and directly-assessed expressive vocabulary measured by the Expressive Vocabulary Test-2 at 36 months. Analyses: 1) Adjusted linear regression models fitted separately for each predictor variable (maternal responsive behaviour) and outcome variable (language measures). Potential confounders included treatment status, gender, age at follow-up, maternal education, socio-economic status (as measured by SEIFA) and birth order. 2) Adjusted linear regression models fitted separately for the primary predictor of overall responsiveness and language outcomes. The overall responsiveness score was a composite score of the responsive behaviours shown to predict language scores in the first set of analyses. Models also included potential risk factors and earlier measures of language. Results: 225 of the 251 (89.6%) dyads were followed up at 36 months. Expansions, imitations and responsive questions strongly predicted better 24 and 36 month receptive and expressive language and predicted better scores on expressive vocabulary measures at ages 24 and 36 months. Unexpectedly, labelling predicted worse expressive language, while interpretations and supportive directives were not predictive. Adjusting for 24 month language scores attenuated most associations, however, expansions continued to strongly predict language outcomes at 36 months. The overall responsiveness score was the strongest predictor of receptive and expressive language at 24 months after adjusting for risk factors and earlier language scores. This overall score also predicted language outcomes at 36 months, but only accounted for a small amount of explained variation in language scores once risk factors and earlier language scores were included. Conclusions: This large prospective longitudinal study complements previous clinical studies by demonstrating similarly strong relationships between maternal responsive behaviours and language outcomes in a population-based sample of slow-to-talk toddlers. Good quality parent-child interactions defined by maternal use of responsive behaviours, such as expansions, imitations and responsive questions, are strong predictive markers of better language outcomes. Because the findings attenuated (though did not disappear) with inclusion of earlier language scores, the directionality of these interactions remains uncertain. Nonetheless, this study provides further understanding into the reciprocal nature of parent-child interactions in toddlers, suggesting both that the mother’s maternal linguistic behaviours influence the child, and that the child’s involvement as a communicative partner may also influence the mother. Several research implications arise from these findings. First, measures of responsiveness could be further developed to provide health professionals with a tool to improve the ability to identify those toddlers most likely to experience lasting language delay. Thus, slow-to-talk toddlers whose mothers also score low on responsiveness would be deemed to be at greatest risk of persistent language problems. Second, further intervention trials could be mounted to determine modifiable causal pathways within these relationships, i.e., whether effectively promoting maternal responsiveness also enhances language learning

Maternal linguistic input and child language in a cohort at risk of experiencing social adversity

Specific features of adult linguistic input may play a larger, or smaller role, at different child ages, across different language outcomes, in different cohorts. This prospective, longitudinal study explored associations between the quantity and quality (i.e. diversity and responsiveness) of maternal linguistic input and child language. This study was derived from an Australian population-based intervention trial. Participants were mother–child dyads at risk of experiencing social adversity (n = 136). Home visits were conducted at 24 and 36 months. At the 24-month visit, mother–child free-play videos were collected. Seven aspects of maternal linguistic input were measured from videos: imitations, expansions, wh-questions, labels, word types, word tokens and mean length of utterance (MLU). Child language was assessed using a standardized measure at 36 months. Maternal MLU and imitations were associated with overall language and expressive vocabulary scores; wh-questions were associated with receptive language scores. By exploring quantity and quality, we can appreciate the differential contribution of adult linguistic input to early language abilities in different groups of children. Our findings highlight how imitations of early words/sounds and asking children wh-questions may foster expressive and receptive language development. These findings may be helpful to consider when selecting strategies for use in parent-implemented language promotion activities

Effects of maternal depression on maternal responsiveness and infants’ expressive language abilities

High levels of maternal responsiveness are associated with healthy cognitive and emotional development in infants. However, depression and anxiety can negatively impact individual mothers’ responsiveness levels and infants’ expressive language abilities. Australian mother-infant dyads (N = 48) participated in a longitudinal study examining the effect of maternal responsiveness (when infants were 9- and 12-months), and maternal depression and anxiety symptoms on infant vocabulary size at 18-months. Global maternal responsiveness ratings were stronger predictors of infants’ vocabulary size than levels of depression and anxiety symptoms. However, depression levels moderated the effect of maternal responsiveness on vocabulary size. These results highlight the importance of screening for maternal responsiveness–in addition to depression–to identify infants who may be at developmental risk. Also, mothers with elevated depression need support to first reduce their symptoms so that improvements in their responsiveness have the potential to be protective for their infant’s language acquisition